| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,578 |
4,571 |
$253K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,159 |
6,839 |
$157K |
| D1120 |
Prophylaxis - child |
3,899 |
3,892 |
$152K |
| D1110 |
Prophylaxis - adult |
1,665 |
1,660 |
$141K |
| D0274 |
Bitewings - four radiographic images |
4,827 |
4,818 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,445 |
1,444 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,476 |
6,465 |
$81K |
| D0330 |
Panoramic radiographic image |
1,565 |
1,561 |
$46K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
616 |
423 |
$41K |
| D1351 |
Sealant - per tooth |
1,026 |
222 |
$35K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
162 |
117 |
$19K |
| D0272 |
Bitewings - two radiographic images |
756 |
756 |
$9K |
| D2140 |
|
59 |
39 |
$3K |
| D0350 |
|
237 |
201 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
25 |
25 |
$940.00 |